Percutaneous Ultrasonic Debridement for Heterotopic Ossification in Plantar Fasciopathy: A Case Report

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

 

I found your presentation to be successful. Your writing style is overly informal; it would be improved by proofreading and academic language editing. 

It is interesting to note that the definitions of heel spur-related plantar fasciitis and heterotopic ossification are intertwined in your text. You have correctly described a case of heterotopic ossification and structured the title and introduction accordingly. However, upon further review, it appears that the case you are presenting is in fact that of heel spur and associated plantar fasciitis. It is recommended that the title and the text be restructured accordingly. If you are insistent on the diagnosis of heterotopic ossification, I would require evidence in the form of discussion and literature support that would demonstrate why the heel spur and associated plantar fasciitis case should be labelled as such.

I would also advise you to expand upon your purpose statement and formulate your hypothesis.

Comments on the Quality of English Language

 

The writing style is overly informal; it would be improved by proofreading and academic language editing. 

 

Author Response

Dear reviewer 1. Thank you for your kind and very helpful comments. I have looked through the manuscript following your recommendations and suggestions. I will show to you the changes we have made due to your review, which are underlined in green in the paper.

In the text, at the beginning of the introduction, lines 40–44, it is explained that the diagnosis was heterotopic ossification, since a bone with trabeculae was formed rather than a calcium deposit, which would correspond to a calcification. We have specified that, being separated from the insertion site, this allows us to differentiate it from a heel spur or enthesophyte.

 

Reviewer 2 Report

Comments and Suggestions for Authors

1. Abstract states an 8-month history but the main text reports 2 years. Please correct this inconsistency and ensure the same duration is used throughout the manuscript.
2. Clarify how you distinguished heterotopic ossification from simple calcification by listing the specific imaging criteria (MRI/CT/US) used, or state that no histology was obtained; include representative images if possible.
3. Confirm whether the contralateral foot was imaged and, if available, provide a comparison radiograph to demonstrate that the lesion is focal and unilateral.
4. State whether axial radiographs were reviewed to exclude DISH.
5. One-month follow-up is short; please provide longer clinical and/or imaging follow-up if available, or note the short follow-up as a limitation.

Author Response

Dear reviewer 2. Thank you for your kind and very helpful comments. I have looked through the manuscript following your recommendations and suggestions. I will show to you the changes we have made due to your review, which are underlined in yellow in the paper.

We changed the inconsistency in the abstract, because was a history of 2 years

• We have clarified in line 77-80 the rationale for establishing the diagnosis of HO.

• A contralateral radiograph of the unaffected side was not performed in order to avoid unnecessary radiation exposure; however, an ultrasound examination was carried out, which showed no evidence of the lesion in the contralateral foot.

• We did not perform axial radiographs.

• We added in the line 200 of the discussion the statment of the short follow up

Reviewer 3 Report

Comments and Suggestions for Authors

Thank you for your effort on the study.

My comments:

The surgical treatment options should be mentioned in the introduction section.

In the results section, please report the follow-up time. If it is one month, it is too short.

In the discussion section, please discuss the Tenex system techniques, the advantages, and the disadvantages compared to previous surgical techniques. 

In Figure 2, it could be better to show how to introduce the Tenex system into the wound.

Author Response

Dear reviewer 3. Thank you for your kind and very helpful comments. I have looked through the manuscript following your recommendations and suggestions. I will show to you the changes we have made due to your review, which are underlined in blue in the paper.

• We have included in the introduction other types of surgical approaches that could be used, along with their potential adverse effects or disadvantages.
• However, we did not include them in the discussion due to the lack of studies on this specific pathology from which supporting literature could be provided.
• The aim of the study was to demonstrate that the Tenex device allowed us to remove this type of bone growth. Subsequently, the patient received treatment for plantar fasciopathy, as our primary objective was to alleviate the sensation of “stepping on a stone.”
• we modified the figure 2 to explain the introduction of the tenex device